EXAMINATION ENROLMENT FORM
JULY 2016
BOOK YOUR EXAM ENTRY ONLINE www.cips.org/MyCIPS
Please complete this form in full and return to:
CIPS Examinations, PO Box 9186, Adamsway, Mansfield, Nottinghamshire NG18 9DX
Tel: +44 (0) 845 880 1188 Fax No: +44 (0) 845 880 1187 Email: exams@cips.org
PART 1 - ABOUT YOU: PLEASE COMPLETE IN FULL
Name:
Membership No:
Tel:
Mobile:
Email:
Address:
This form should be completed by students wishing to sit their examinations in the countries listed below
AFGHANISTAN
GHANA
NIGER
BANGLADESH
GUINEA
NIGERIA
BENIN
GUINEA-BISSAU
RWANDA
BURKINA FASO
HAITI
SIERRA LEONE
BURUNDI
KENYA
SOMALIA
CAMBODIA
KOREA DEM. REP. (NORTH)
SOUTH SUDAN
CENTRAL AFRICAN REP.
KRYGYZ REP.
ST. HELENA
CHAD
LIBERIA
TAJIKISTAN
COMOROS
MADAGASCAR
TANZANIA
CONGO, DEM. REP.
MALAWI
TOGO
ERITREA
MALI
UGANDA
ETHIOPIA
MYANMAR
ZAMBIA
GAMBIA
NEPAL
ZIMBABWE
EXAM CENTRE INFORMATION
If you are registered with a study centre who also provide examination facilities, please select this centre as your exam centre. If you are a self-study
or distance learning student, choose from any of the centres that are open to all students. A current list of ‘CIPS approved exam centres’ can be
found at www.cips.org under qualifications, Find an Exam Centre.
In addition to the examination fee payable to CIPS at the point of booking, a supplementary administrative fee will be charged by the examination
centre. You are advised to contact the centre before completing a booking for details of this supplementary fee. If you do not pay the required fee,
you may not be able to take your exam and you may lose your assessment fee.
The following examination centres accept all students and will not charge a supplementary fee;
Accra British Council
GHANA
Kampala British Council
UGANDA
Kumasi British Council
GHANA
Kitwe British Council
ZAMBIA
Nairobi British Council
KENYA
Livingstone British Council
ZAMBIA
Blantyre British Council
MALAWI
Lusaka British Council
ZAMBIA
Lilongwe British Council
MALAWI
Ndola British Council
ZAMBIA
Abuja British Council
NIGERIA
Bulawayo British Council
ZIMBABWE
Lagos British Council
NIGERIA
Harare British Council
ZIMBABWE
Port Harcourt British Council
NIGERIA
You must complete an enrolment form for each examination session.
INTERNATIONAL ENTRY CLOSURE: Friday 27th May 2016 RESULTS PUBLISHED: Wednesday 5th October 2016
Please note that all Reasonable Adjustment requests must be submitted with your enrolment form before the Entry Closure date.
00ILI
Membership no.
0 0
PART 2 - YOUR EXAMINATION CHOICES
Read the CIPS Examination Enrolment Guidance booklet carefully about how to complete this section of the form.
Candidates are required to complete all parts of this form - if a mistake is made we may need to return your form which will result in enrolment delays.
I am currently studying at: (Record self study if you are not registered with a study centre) ������������������������������������������������������������������������������������������������
I wish to sit my examination(s) at the following exam centre: (Please select two options in case Option 1 is not available)
Option 1......................................................................................... Option 2...................................................................................................
Examination subjects: Please put a cross in the box(es) to indicate the examinations that you wish to be entered for.
Certificate in procurement & supply operations Advanced certificate in procurement & supply operations
NC1 Procurement & supply principles AC1 Procurement & supply environments
NC2 Procurement & supply functions AC2 Procurement & supply operations
NC3 Procurement & supply processes AC3 Procurement & supply workflow
NC4 Procurement & supply administration AC4 Inventory & logistics operations
NC5 Procurement & supply stakeholders AC5 Procurement & supply relationships
Diploma in procurement & supply Advanced diploma in procurement & supply
D1 Contexts of procurement & supply AD1 Management in procurement & supply
D2 Business needs in procurement & supply AD2 Managing risks in supply chains
D3 Sourcing in procurement & supply AD4 Category management in procurement & supply
D4 Negotiating & contracting in procurement & supply AD5 Sustainability in supply chains
D5 Managing contracts & relationships in procurement & supply AD6 Operations management in supply chains
Professional diploma in procurement & supply
PD1 Leadership in procurement & supply PD2 Corporate & business strategy
PD4 Supply chain diligence
PD5 Programme & project management
PD6 Legal aspects in procurement & supply (UK)
PART 3 - SIGNATURE AND DATE
The provision of examination service by CIPS contained in this examination enrolment form is subject to the conditions of entry provided in the
CIPS Examination Enrolment Guidance booklet. They can also be found at www.cips.org under Qualifications, Assessments and Enrolment Guidelines.
By returning this form you acknowledge that you have read, understood and accept those conditions, and which include exclusions and limitations of liability
on the part of CIPS.
This form must be signed and each section completed.
I agree to the conditions of entry
into the CIPS examination(s).
Signed.................................................................................................
Certificate fee(s)
£70 per exam
Total £
Diploma fee(s)
£74 per exam
Total £
Date......................................................
PART 4 - HOW TO PAY
Please note that your form will not be processed if your payment is not received with this form.
I have enclosed a UK sterling cheque (made payable to CIPS)
Name of Cardholder
Money on CIPS account
Paid through British Council
Card Number (16 digits)
Paid by BACS (remittance advice must be enclosed)
Credit Card
Debit Card
Issue Number
Expiry Date
Visa
Amex
m
Card Security Code
There is no fee if you pay by debit card. A non-refundable 2% fee will be incurred if you pay by credit card.
MasterCard
m
Maestro
/
y
y